| NPI | 1396124509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN22336) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401414836) |
| Enumeration Date | 2015-05-20 |
| Last Update Date | 2022-08-17 |